When Breast Cancer Comes Back
Recurrence is always possible. But when the cancer comes back, where it is and how it behaves all affect the outcome.
It can happen a year after you finish treatment for breast cancer, or five,
10, even 20 years later. You find another lump, or a shadow appears on one of
the mammograms you're having much more often now. Is the cancer back?
Every woman who's had breast cancer knows that recurrence is possible. Some
may do a better job than others at keeping that worry in a tightly closed box
on the other side of the room. But sometimes -- such as at follow-up visits
with the oncologist -- it's hard to avoid.
And sometimes, the worry proves true. After all you and your doctors did,
after those scary and exhausting and painful months of treatment, the cancer is
rearing its ugly head again.
How often does breast cancer recur? That depends on a number of factors,
- Size of the original tumor
- Number of lymph nodes involved, if any
- How aggressive the cancer was
- How well you responded to your first course of treatment
For example, if your original tumor was less than 1 centimeter and had not
spread to the lymph nodes, the chance of the cancer's returning may be only 5%.
If you had a large tumor with multiple lymph nodes involved, the odds that it
will in time recur can be significantly higher -- 50% or greater for some
Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic -- the cancer has come back
not in the breast (or not only in the breast), but elsewhere in the body as
well. That's a much more serious situation (see ). Or, it may have come back
much as the first time you were diagnosed, as a "new" cancer, and is
treated as such.
Be aware that many people talk about recurrence and metastasis in the same
breath. But they are not the same thing. If you have had a local recurrence,
when the cancer remains confined to your breast, the good news is that your
prognosis is not necessarily any worse than it was the first time.
"Whether it's a recurrence of the original cancer or a new primary
cancer in the other breast, in both cases we assume we're dealing with a
curable situation, and we attempt to think about those patients as we would
anyone with a new presentation," says Clifford Hudis, MD, chief of the
Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New
If, for example, you finished treatment for breast cancer seven or eight
years ago, any recurrence or new cancer ("new primaries" are not
common, but they do happen) would be treated largely as an entirely new
"That woman will not only undergo surgery, but may well receive
additional therapy that doesn't ignore the fact that she had a previous cancer,
but recognizes that seven years out, her prognosis from the first cancer is
excellent," says Eric Winer, MD, director of the Breast Program at the
Dana-Farber Cancer Institute in Boston.